Working together better for mental health in children and young people during a pandemic: experiences from North Central London during the first wave of COVID-19

Direct risk from infection from COVID-19 for children and young people (CYP) is low, but impact on services, education and mental health (so-called collateral damage) appears to have been more significant. In North Central London (NCL) during the first wave of the pandemic, in response to the needs and demands for adults with COVID-19, general paediatric wards in acute hospitals and some paediatric emergency departments were closed. Paediatric mental health services in NCL mental health services were reconfigured. Here we describe process and lessons learnt from a collaboration between physical and mental health services to provide care for CYP presenting in mental health crisis. Two new ‘hubs’ were created to coordinate crisis presentations in the region and to link community mental health teams with emergency departments. All CYP requiring a paediatric admission in the first wave were diverted to Great Ormond Street Hospital, a specialist children’s hospital in NCL, and a new ward for CYP mental health crisis admissions was created. This brought together a multidisciplinary team of mental health and physical health professionals. The most common reason for admission to the ward was following a suicide attempt (n=17, 43%). Patients were of higher acute mental health complexity than usually admitted to the hospital, with some CYP needing an extended period of assessment. In this review, we describe the challenges and key lessons learnt for the development of this new ward setting that involved such factors as leadership, training and also new governance processes. We also report some personal perspectives from the professionals involved. Our review provides perspective and experience that can inform how CYP with mental health admissions can be managed in paediatric medical settings

Thrive: The AFC-Tavistock Model for CAMHS

All ideas in this paper and related to this model are independent of any organisational affiliations, committee membership or other official capacities of any of the authors, other than their roles within the Anna Freud Centre and The Tavistock and Portman NHS Foundation Trust. ..

Campus Vol V N 2

Gillies, Jean. Cover. Picture. 0. Gould, Jim. A Christmas Carol...A Modern Tragedy . Prose. 3. MacDonald, Honnie. More Sinned Against . Prose. 4. Olwin, Lynn. Campus Calender Queens For Christmas . Poem. 7. Trimble, John. Campus Calender Queens For Christmas . Picture. 7. Bedell, Barrie and John Hodges. Shopping Guide For Christmas Prose. 15. Yearling, Joe. Sport Shorts . Prose. 16. Dresser, Bill. Tenth Anniversary . Prose. 18. Gleason, Sally. Lost Christmas . Prose. 17

Routine nasogastric suction may be unnecessary after a pancreatic resection

AbstractBackgroundMost surgeons routinely place a nasogastric tube at the time of a pancreatic resection. The goal of the present study was to evaluate the outcome when a pancreatic resection is performed without routine post-operative nasogastric suction.MethodsOne hundred consecutive patients underwent a pancreatic resection (64a pancreaticoduodenectomy, 98% pylorus sparing and 36a distal pancreatectomy). In the first cohort (50 patients), a nasogastric tube was routinely placed at the time of surgery and in the second cohort (50 patients) the nasogastric was removed in the operating room. Outcomes for these two cohorts were recorded in a prospective database and compared using the χ2 or Fisher's exact test and Wilcoxon's rank-sum test.ResultsDemographical, surgical and pathological details were similar between the two cohorts. A post-operative complication occurred in 22 (44%) in each group (P= 1.000). There were no statistically significant differences in the frequency or severity of complications, or length of stay between groups. The spectrum of complications experienced by the two cohorts was similar including complications that could potentially be related to the use of nasogastric suction such as delayed gastric emptying, anastomotic leak, wound dehiscence and pneumonia. There was no difference between the two groups in the number of patients who required post-operative nasogastric tube placement (or replacement) [2 (4%) vs. 4 (8%), P= 0.678].ConclusionIt may be safe to place a nasogastric tube post-operatively in a minority of patients after a pancreatic resection and spare the majority the discomfort associated with routine post-operative nasogastric suction

THRIVE elaborated

Introduction to THRIVE Elaborated: Since we published the THRIVE framework a year ago in November 2014 it has generated a lot of interest. We are delighted by this. We want to take this opportunity to clarify and elaborate as relevant, including addressing areas of potential confusion, as well as updating the document in light of our emerging thinking and elaboration of elements of the framework. It is important to note that nothing relating to the central ideas of the framework has been changed

Exile Vol. I No. 1

SHORT STORIES Louie, the Cab Driver by Lynn Herrick 5 Anna Dietrich by Jane Erb 13 Ground-Level Appointment by Keith Opdahl 15 Conveyor Belt by George Mahon 30 ESSAYS The Examined Life Re-Examined by Doug James 10 Concerning Flem Snopes and Benjamin Franklin by David Schieber 24 Who Fathered the Footnote? by Diane Hostetler 28 POETRY Carousel by Sally Falch 12 March and Yesterday by Midge Greenlee 23 Amusement Muse by John Miller 27 North Watch by John Hodges 27 Pursuit by James Bowman 32 Three Poems by Jean Duncan: Venice 33 Innsbruck 34 Darmstadt 3

Sharing Secrets with Agents: Improving Sensitive Disclosures using Chatbots

There is an increasing shift towards the use of conversational agents, or chatbots, thanks to their inclusion in consumer hardware (e.g. Alexa, Siri and Google Assistant) and the growing number of essential services moving online. A chatbot allows an organisation to deal with a large volume of user queries with minimal overheads, which in turn allows human operators to deal with more complex issues. In this paper we present our work on maximising responsible, sensitive disclosures to chatbots. The paper focuses on two key studies, the first of which surveyed participants to establish the relative sensitivity of a range of disclosures. From this, we found that participants were equally comfortable making financial disclosures to a chatbot as to a human. The second study looked to support the dynamic personalisation of the chatbot in order to improve the disclosures. This was achieved by exploiting behavioural biometrics (keystroke and mouse dynamics) to identify demographic information about anonymous users. The research highlighted that a fusion approach, combining both keyboard and mouse dynamics, was the most reliable predictor of these biographic characteristics

Ampullary cancers harbor ELF3 tumor suppressor gene mutations and exhibit frequent WNT dysregulation

The ampulla of Vater is a complex cellular environment from which adenocarcinomas arise to form a group of histopathologically heterogenous tumors. To evaluate the molecular features of these tumors, 98 ampullary adenocarcinomas were evaluated and compared to 44 distal bile duct and 18 duodenal adenocarcinomas. Genomic analyses revealed mutations in the WNT signaling pathway among half of the patients and in all three adenocarcinomas irrespective of their origin and histological morphology. These tumors were characterized by a high frequency of inactivating mutations of ELF3, a high rate of microsatellite instability, and common focal deletions and amplifications, suggesting common attributes in the molecular pathogenesis are at play in these tumors. The high frequency of WNT pathway activating mutation, coupled with small-molecule inhibitors of β-catenin in clinical trials, suggests future treatment decisions for these patients may be guided by genomic analysis

THRIVE framework for system change

What is the THRIVE Framework? The THRIVE Framework provides a set of principles for creating coherent and resource-efficient communities of mental health and wellbeing support for children, young people and families.It aims to talk about mental health and mental health support in a common language that everyone understands.The Framework is needs-led. This means that mental health needs are defined by children, young people and families alongside professionals through shared decision making. Needs are not based on severity, diagnosis or health care pathways